Translating diabetes research findings into real world primary care practice has been a challenge. Previous work has shown that the major determinants of health care quality are structures (i.e., numbers of providers) and processes (i.e., continuity with a provider) of care. A limited understanding of primary care practices and a lack of real world laboratories have hindered efforts to investigate how structures and processes of care are related to the quality of diabetes care within this setting. The candidate?s career goal is to establish himself as an independent investigator and expert in rigorous and innovative diabetes prevention and control research within primary care settings that will have an impact on health care policy and practice. The proposed Mentored Clinical Scientist Career Development Award will advance his career goals by integrating mentoring, training and focused research to meet two specific career development objectives: 1) To become an expert in content and methods specific to the conduct of research on the quality of diabetes care in primary care practice-based research networks; and 2) To use these skills to understand the structures and processes of primary care with the goal of improving the quality of diabetes care in away that is pragmatic for primary care practices. These two objectives will be met through an integrated program of mentoring, training and research within a rich and supportive research environment in a health services research center. An integrated series of studies are planned that will lead to an R01 clinical trial proposal early in the fourth year of this award. The first study will describe the facilitators and barriers experienced by primary care clinic organizations to implementing clinical practice guidelines, including diabetes clinical practice guidelines, within the competing demands of the primary care setting. The findings of this study will be used to guide the analysis of data from the second study and the design of the data collection instrument for the third study. The second study, the Direct Observation of Diabetes Care, will describe and assess the relationship between specific structures and process of care and the quality of diabetes care in 20 primary care practices. The third study will add to the first two studies by describing how primary care providers prioritize among competing clinical practice guidelines in a diabetic patient with multiple co-existing chronic conditions.